Ten-year follow-up study of elderly with dementia in the community

目的：了解老年痴呆患者基线研究后10年的死亡率、死亡原因及死亡地点。研究对象：1992年日本K市老年人基线研究中诊断为痴呆的老年人（n=201）。方法：经有关部门批准，根据生命统计记录确认死亡日期、原因和地点。结果：201例患者中，死亡170例，外迁3例，存活28例。死亡人数是K市同龄人口预期死亡人数的1.42倍。Kaplan-Meier生存分析平均生存期为4.32年。考克斯比例风险模型分析显示年龄、性别、长期卧床、行走障碍是影响死亡的重要因素。心血管疾病是老年痴呆症患者的主要死因。在22名存活者中，居家2年者的ADL下降幅度低于机构化护理者，能够继续居家护理10年的因素有ADL、卧床程度、照顾者对被照顾者的情感亲和力、照顾意愿。预防心血管疾病不仅对痴呆症的一级预防有效，而且对预防老年痴呆症患者的早期死亡也有效。保持老年痴呆症患者不卧床，维持其步行能力，是老年痴呆症患者长寿和高质量生活的重要保证。

Objectives : To investigate the mortality, cause of death and the place of death among the elderly with dementia in 10 years after the baseline study. Also, to study the factors that enabled the elderly with dementia been cared at home by family caregivers for 10 years.Subjects : The elderly who were diagnosed dementia in the baseline study for the whole elderly population in 1992, in K city, Japan(n=201).Methods : The date, cause and the place of death were confirmed with the Vital Statistics Record, with the permission of the Ministry concerned. The survivors were interviewed to study ADL, caregivers' status.Results : Among 201 subjects, 170 died, 3 moved out of the city and 28 survived. The number of death was 1.42 times higher compared to those expected for the population of the same age in K city. The average survival time was 4.32 years with Kaplan-Meier survival analysis. Age class, gender, being bed-ridden and impaired walking were significant factors for death by Cox proportional hazard model. CVD was the dominant cause of death among the demented elderly. Among 22 survivors interviewed, the declination of the ADLs of those stayed at home in 2 years was lower than those institutionalized.The factors enabled to continue to be cared at home for 10 years were, ADLs and the level of bed-ridden, the caregiver's feeling affinity to the subject, and their will to care.Conclusion : The mortality of the elderly with dementia was higher compared to the elderly population. To prevent CVD will be effective not only for the primary prevention for dementia but also for the prevention of early death of demented elderly. To keep being free from bed-ridden, and to maintain gait ability are important for demented elderly to live long and high quality life.